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    <title>Part Five</title>
    
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  	<h1>PART FIVE: Factors Influencing Your Treatment Choice for Prostate Cancer</h1>
  	
  	<h4 class="first">There are nine factors identified as being important to men as they make a treatment <br>
  						choice. These factors are arranged into 36 pairs. </h4>
  	<h4 class="second">From each of the following pairs, check or circle the ONE statement from each pair that <br>
  						describes the factor that will have the most influence on how you will decide which <br>
  						treatment is best for you. It is important to make a selection for each pair.</h4><br>
  						
    <form>
    		<input type="radio" name="q1"> (1). Impact of treatment on urinary function. <br>
            <input type="radio" name="q1"> (2). Impact of treatment on sexual function. <br><br>
            
            <input type="radio" name="q2"> (3). Impact of treatment on bowel function. <br>
            <input type="radio" name="q2"> (9). Impact of spouse/family member’s opinion on treatment choice.  <br><br>
            
            <input type="radio" name="q3"> (4). Impact of treatment on work and leisure activities. <br>
            <input type="radio" name="q3"> (8). Impact of urologist’s treatment recommendation. <br><br>
            
            <input type="radio" name="q4"> (5). Differences in invasiveness of treatment options (e.g. surgery, radiation, active <br>
           	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;surveillance). <br>
            <input type="radio" name="q4"> (7). Impact of treatment on survival <br><br>
            
            <input type="radio" name="q5"> (6). Impact of a friend or acquaintance’s experience with a specific treatment. <br>
            <input type="radio" name="q5"> (1). Impact of treatment on urinary function. <br><br>
            
            <input type="radio" name="q6"> (2). Impact of treatment on sexual function. <br>
            <input type="radio" name="q6"> (3). Impact of treatment on bowel function. <br><br>
            
            <input type="radio" name="q7"> (9). Impact of spouse/family member’s opinion on treatment choice. <br>
            <input type="radio" name="q7"> (4). Impact of treatment on work and leisure activities. <br><br>
            
            <input type="radio" name="q8"> (8). Impact of urologist’s treatment recommendation. <br>
            <input type="radio" name="q8"> (5). Differences in invasiveness of treatment options (e.g. surgery, radiation, active <br>
           	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;surveillance). <br><br>
            
            <input type="radio" name="q9"> (7). Impact of treatment on survival <br>
            <input type="radio" name="q9"> (6). Impact of a friend or acquaintance’s experience with a specific treatment. <br><br>
            
            <input type="radio" name="q10"> (1). Impact of treatment on urinary function. <br>
            <input type="radio" name="q10"> (3). Impact of treatment on bowel function. <br><br>
            
            <input type="radio" name="q11"> (4). Impact of treatment on work and leisure activities. <br>
            <input type="radio" name="q11"> (2). Impact of treatment on sexual function. <br><br>
            
            <input type="radio" name="q12"> (5). Differences in invasiveness of treatment options (e.g. surgery, radiation, active <br>
           	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;surveillance). <br>
            <input type="radio" name="q12"> (9). Impact of spouse/family member’s opinion on treatment choice. <br><br>
            
            <input type="radio" name="q13"> (6). Impact of a friend or acquaintance’s experience with a specific treatment. <br>
            <input type="radio" name="q13"> (8). Impact of urologist’s treatment recommendation. <br><br>
            
            <input type="radio" name="q14"> (7). Impact of treatment on survival <br>
            <input type="radio" name="q14"> (1). Impact of treatment on urinary function. <br><br>
            
            <input type="radio" name="q15"> (3). Impact of treatment on bowel function. <br>
            <input type="radio" name="q15"> (4). Impact of treatment on work and leisure activities. <br><br>
            
            <input type="radio" name="q16"> (2). Impact of treatment on sexual function. <br>
            <input type="radio" name="q16"> (5). Differences in invasiveness of treatment options (e.g. surgery, radiation, active <br>
           	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;surveillance). <br><br>
            
            <input type="radio" name="q17"> (9). Impact of spouse/family member’s opinion on treatment choice. <br>
            <input type="radio" name="q17"> (6). Impact of a friend or acquaintance’s experience with a specific treatment. <br><br>
            
            <input type="radio" name="q18"> (8). Impact of urologist’s treatment recommendation. <br>
            <input type="radio" name="q18"> (7). Impact of treatment on survival <br><br>
            
            <input type="radio" name="q19"> (1). Impact of treatment on urinary function. <br>
            <input type="radio" name="q19"> (4). Impact of treatment on work and leisure activities. <br><br>
            
            <input type="radio" name="q20"> (5). Differences in invasiveness of treatment options (e.g. surgery, radiation, active <br>
           	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;surveillance). <br>
            <input type="radio" name="q20"> (3). Impact of treatment on bowel function. <br><br>
            
            <input type="radio" name="q21"> (6). Impact of a friend or acquaintance’s experience with a specific treatment. <br>
            <input type="radio" name="q21"> (2). Impact of treatment on sexual function. <br><br>
            
            <input type="radio" name="q22"> (7). Impact of treatment on survival <br>
            <input type="radio" name="q22"> (9). Impact of spouse/family member’s opinion on treatment choice. <br><br>
            
            <input type="radio" name="q23"> (8). Impact of urologist’s treatment recommendation. <br>
            <input type="radio" name="q23"> (1). Impact of treatment on urinary function. <br><br>
            
            <input type="radio" name="q24"> (4). Impact of treatment on work and leisure activities. <br>
            <input type="radio" name="q24"> (5). Differences in invasiveness of treatment options (e.g. surgery, radiation, active <br>
           	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;surveillance). <br><br>
            
            <input type="radio" name="q25"> (3). Impact of treatment on bowel function. <br>
            <input type="radio" name="q25"> (6). Impact of a friend or acquaintance’s experience with a specific treatment. <br><br>
            
            <input type="radio" name="q26"> (2). Impact of treatment on sexual function. <br>
            <input type="radio" name="q26"> (7). Impact of treatment on survival <br><br>
            
            <input type="radio" name="q27"> (9). Impact of spouse/family member’s opinion on treatment choice. <br>
            <input type="radio" name="q27"> (8). Impact of urologist’s treatment recommendation. <br><br>
            
            <input type="radio" name="q28"> (1). Impact of treatment on urinary function. <br>
            <input type="radio" name="q28"> (5). Differences in invasiveness of treatment options (e.g. surgery, radiation, active <br>
           	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;surveillance). <br><br>
            
            <input type="radio" name="q29"> (6). Impact of a friend or acquaintance’s experience with a specific treatment. <br>
            <input type="radio" name="q29"> (4). Impact of treatment on work and leisure activities. <br><br>
            
            <input type="radio" name="q30"> (7). Impact of treatment on survival <br>
            <input type="radio" name="q30"> (3). Impact of treatment on bowel function. <br><br>
            
            <input type="radio" name="q31"> (8). Impact of urologist’s treatment recommendation. <br>
            <input type="radio" name="q31"> (2). Impact of treatment on sexual function. <br><br>
            
            <input type="radio" name="q32"> (9). Impact of spouse/family member’s opinion on treatment choice. <br>
            <input type="radio" name="q32"> (1). Impact of treatment on urinary function. <br><br>
            
            <input type="radio" name="q33"> (5). Differences in invasiveness of treatment options (e.g. surgery, radiation, active <br>
           	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;surveillance). <br>
            <input type="radio" name="q33"> (6). Impact of a friend or acquaintance’s experience with a specific treatment. <br><br>
            
            <input type="radio" name="q34"> (4). Impact of treatment on work and leisure activities. <br>
            <input type="radio" name="q34"> (7). Impact of treatment on survival <br><br>
            
            <input type="radio" name="q35"> (3). Impact of treatment on bowel function. <br>
            <input type="radio" name="q35"> (8). Impact of urologist’s treatment recommendation. <br><br>
            
            <input type="radio" name="q36"> (2). Impact of treatment on sexual function. <br>
            <input type="radio" name="q36"> (9). Impact of spouse/family member’s opinion on treatment choice. <br><br>
            
            Are there any other factors having an influence on your treatment decision? <br>
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            </textarea><br><br>
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